Smaller right vagus cross-sectional area is correlated with decreased esophageal motility

초록

Background and aims: Parkinson's disease (PD) is a neurodegenerative disorder characterized by pathological accumulation of alpha-synuclein. A gut-to-brain transmission route via the vagus nerve, especially involving the dorsal motor nucleus, has been proposed. Gastrointestinal symptoms are common in PD, with more than 80 % of patients reporting dysphagia over the course of the disease. This study aimed to examine the association between vagus nerve atrophy and esophageal motility in early-stage PD. Methods: Between September 2023 and September 2024, 66 early PD patients underwent high-resolution esophageal manometry (HRM), vagus nerve sonography, autonomic function tests, structured clinical interviews, and neurologic examinations. Patients were grouped by vagus nerve cross-sectional area (CSA) into small and large CSA groups based on the median. Variables with a p-value <0.1 in univariate logistic regression were included in the multivariate analysis. Results: Thirty-two patients were classified into the small vagus group and 34 into the large group. No age difference was noted (66.3 vs. 66.1 years). Variables included in the regression analysis were age, sex, hypertension, diabetes, levodopa equivalent daily dose, presence of olfactory dysfunction, and HRM parameters. Striated esophagus contractile integral (OR = 1.01, p = 0.049) and distal latency (OR = 2.46, p = 0.019) were found to be significantly associated with the small vagus group. Conclusions: A smaller vagus nerve cross-sectional area is significantly associated with decreased esophageal motility in PD patients. This study provides the first objective evidence that decreased esophageal motility in PD is associated with vagus nerve atrophy, supporting the underlying autonomic dysfunction.